TBI Flashcards
(33 cards)
Types of TBI- TAN
- Traumatic (closed & Open)
- Non-traumatic
- Acquired
Traumatic TBI - closed
- Coupe, contra coupe, shaking baby. Inside brain very sharp, blunt force will create injuries
- DAI
- Secondary- injury Inflammation, swelling of the brain –uncle herniation, hydrocephalus (within 24 hrs) bowel & bladder issues, Autonomic NS issues.
DAI-Diffused axonal injury
Small microscopic injuries that occurs, don’t show up on radiograph but BI still evident and changes in behavior occurs.
Traumatic TBI- Open
- OH injury, GSW, baseball bat etc
- Secondary issue infection
- Herniation out of the opening
Non Traumatic BI- Anoxic
Loss of oxygen more common in pediatrics
Cause- suffocation due to near drowning, carbon monoxide, suffocation
Anoxic BI affects every cell in the brain due to lack of oxygen- every cells die
Observed changes in mental and functional status after a TBI
- Confusion
- Mood
- Vomiting
- Headaches etc. within the first 24hrs of injury
Differentiating TBI
Mild vs. Moderate & severe
Mild TBI= FL2AS2H MDFCWNVP
LOC < 30 min- Overlooked a lot
Issues -Referred to as -post concussive syndrome
- Frustrations
- Loss of sense of smell
- Loss of appetite
- Attention deficits
- Slow thinking
- Sleep disturbances
- Headache
- Memory problems
- Moody/ irritable
- Depression
- Fatigue
- Coupe counter coupe – balance, visual disturbances, attentiveness
- Worst extreme- seizures
- Nausea
- Vomiting
- Pt. gets lost
15% still have slight symptoms upwards to a year
Moderate & severe
- LOC > 30-6h Mod
- LOC 6 hrs or more – severe
Signs & Symptoms of moderate & severe TBI- Cognitive issues CoMP2ILE A
Similar symptoms to mild but magnified
- Concentration
- Memory
- Processing speed
- Perseveration
- Impulsiveness
- Language processing
- Executive functions
- Attention
Signs & Symptoms of moderate & severe TBI- Speech Impairments FIRES
- Fast / slow speech
- Inability to form words
- Reading & writing
- Expressive, receptive
- Slurred speech
Signs & Symptoms of moderate & severe TBI- Foreign accent syndrome
Pt. acquires a foreign accent after the injury
Signs & Symptoms of moderate & severe TBI- Sensory & Vision
Sensory
All could be affected, gone fully, part etc depending on affected pathway
Vision
- Complete loss
- Diplopia- week muscles
- Blurred vision
- Distance vision affected
- Nystagmus
- Photophobia- light sensitivity
Signs & Symptoms of moderate & severe TBI- Hearing Smell &Taste
Hearing
Complete / increased sensitivity to sound
Tinnitus – wringing in ears
Smell- Loss or diminished
Taste- loss or diminished
Signs & Symptoms of moderate & severe TBI- Physical changes WFSCBAM
- Weakness
- Flacidity
- Spasticity
- Chronic pain
- Bowel & bladder issues
- ANS issues
- Menstrual cycles
Signs & Symptoms of moderate & severe TBI- Social & emotional ID4EAL
- Irritability
- Dependent behaviors- child like
- Depression
- Disinhibition
- Denial
- Emotional ability to love, be sad, absence etc
- Aggression
- Lack of motivation
Levels of consciousness- AOSMC
- Awake & Alert x3 & x4- orientation to person, place, time event/situation
- Obtunded- sleeps often when aroused decreased alertness and attentive
- Stupor- unresponsive but can be aroused by noxious repeated stimuli
- Minimal Conscious State- Some purposeful movements, open eyes, reaching but don’t know what to do with the object
- Coma
Coma- 2 states
Vegetative
Persistent vegetative
Health care team
- *Doctors -**Stabilize patient
- *PT-** Prevent secondary complications- pneumonia, skin breakdown, contractures, DVT to get patient to interact with the outside environment
How much can they do- walking, dressing, eating, reading etc
How much can we help with- what equipment needed, discharge plan,
Mental & behavioral issues have an impact on therapy careful not to trigger negative emotions
Investigate premorbid behavior
Effects of the injury- accident, abuse etc.
Nature of environment used for therapy- does it promote good or bad behavior
Glasgow coma scale rating
Mild TBI- 13-15
Moderate 9-12
Severe 3- 8
Ranchos Los Amigos Level 1-
No response- pt. appears to be in a deep sleep, no response to stimuli- therapy to prevent sensory deprivation as soon as possible. Keep sensory info going in. Early in therapy- brain still trying to heal, tactile, auditory, olfactory stimulation, ROM teach family, splinting, serial casting - e.g place in DF if in too much PF. 5-15min each session 2-3 times per day.
Ranchos Los Amigos Leve 2
Generalized response- inconsistent non purposeful responses that do not change regardless of stimuli- same response with any stimulus.-still try to prevent sensory deprivation, is the response consistent? at this stage this shows a pattern of their brain waking up- put pt. in different position, lying, sitting, upright. Pre-feeding (swabs with flavor) pt. will typically reflex- decorate room with things they like, pics, music, TV shows. Goals, if 1/4 stimulus goal could b pt. will have 3/4 stimulus to show improvement.
Ranchos Los Amigos Level 3
Localized Response- Vague awareness of themselves- how many responses can we get- decrease the time of response to the stimulus- should be grabbing things by now, throw non-threatening things to them, can they throw back, open/close. Lots of one step tasks, cards with red and blue choose between them. Bathing & showering positive response
Ranchos Los Amigos Level 4
Confused & Agitated- heightened state of activity still have a decreased ability to process info- will try to punch you. Don’t demand participation, simple gross motor, more ball throwing lots of praises do not bring up the negatives. End therapy on a positive note say something they know to do well. More explanation= less agaitation.
